The tobacco control community knows very little about how young adult cigarette smokers form risk perceptions of flavored little cigars and cigarillos (LCC), which researchers believe are key to understanding how to inform regulatory policy as well as prevention methods. In order to accurately determine risk perceptions, sensitive and reliable measures are urgently needed. The long-term goal is to develop health communication interventions that seek to modify risk perceptions of LCC smoking to prevent its initiation among ethnically diverse young adults. The proposed research seeks to fill a knowledge gap by developing a prognostic tool that identifies LCC risk perceptions and predicts LCC initiation behaviors (i.e. susceptibility/intention to smoke) among young adult cigarette smokers. Our preliminary data show that young adult smokers endorse positive attitudes, normative beliefs and self-efficacy toward LCC smoking. We have early indicators that suggest these smokers endorse low perceived risks (i.e., LCC are less harmful than cigarettes) of LCC smoking. Our central hypothesis is that LCC risk perceptions mediate the relationship between attitudes/norms/self-efficacy and susceptibility/intention. We propose 3 specific aims to test our hypothesis: (1) Use qualitative methods to elicit young adult cigarette smokers'beliefs, feelings, and knowledge about flavored LCCs and their risks;(2) To develop a new LCC risk perception scale;and (3) To determine what factors predict LCC susceptibility /intention to smoke. Under the first aim, we will conduct 12 focus groups (n= 8-10/group) to elicit these beliefs, which will inform the scale construction described in Aim 2.
Under Aim 2, we will modify an extant tobacco risk perception scale with qualitative findings from Aim 1 and conduct cognitive testing on the scale among a sample of young adult cigarette smokers. Under 3, we will conduct an online survey among a national probability sample of 18-34 year old cigarette smokers (N=900) and use exploratory structural equation modeling (ESEM) to test our hypotheses. The proposed project will be significant because it is expected to help tobacco control regulatory scientists an policy makers understand the ways in which young adult cigarette smokers think about and respond to risks about flavored LCCs.

Public Health Relevance

The proposed research is relevant to public health because dramatic increases in the consumption of flavored LCC may offset declines seen in cigarette smoking and its associated morbidity and mortality. Thus, the proposed research is relevant to the NIH- FDA's mission of supporting regulation of tobacco products that will reduce the public health toll from tobacco products in the United States.